Elsevier

Journal of Affective Disorders

Volume 222, November 2017, Pages 71-78
Journal of Affective Disorders

Research paper
Risk factors for suicide in offspring bereaved by sudden parental death from external causes

https://doi.org/10.1016/j.jad.2017.06.064Get rights and content

Highlights

  • Single status increased suicide risk, while marriage was protective against suicide.

  • Both marital instability and residential instability increased suicide risk.

  • Low socioeconomic status increased suicide risk in offspring with a single status.

  • Losing both parents and losing a parent to suicide increased suicide risk.

  • There were mostly insignificant gender and age differences.

Abstract

Background

Parentally bereaved offspring have an increased suicide risk as a group, but the ability to identify specific individuals at risk on the basis of risk and protective factors is limited. The present study aimed to investigate to what degree different risk factors influence suicide risk in offspring bereaved by parental death from external causes.

Methods

Based on Norwegian registers, individual-level data were retrieved for 375 parentally bereaved suicide cases and 7500 parentally bereaved gender- and age-matched living controls. Data were analysed with conditional logistic regression.

Results

Bereaved offspring with low social support, indicated by offspring's single status and repeated changes in marital status and residence, had a significantly increased suicide risk compared to bereaved offspring with high social support. Moreover, low socioeconomic status, having an immigration background, having lost both parents and loss due to suicide significantly increased suicide risk.

Limitations

Several variables relevant to bereavement outcome, such as coping mechanisms and the quality of the parent-offspring relationship are impossible to examine by utilizing population registers. Moreover, the availability of data did not enable the measurement of marital stability and residence stability across the entire lifespan for older individuals.

Conclusions

Healthcare professionals should be aware of the additional risk posed by the identified risk factors and incorporate this knowledge into existing practice and risk assessment in order to identify individuals at risk and effectively target bereaved family and friends for prevention and intervention programs. Ideal follow-up for bereaved families should include a specific focus on mobilizing social support.

Introduction

Although the majority of people who have experienced sudden parental death return to their normal life functioning following a period of grief, research has consistently reported that bereaved offspring have an elevated risk of suicide (Agerbo et al., 2002, Gravseth et al., 2010, Guldin et al., 2015, Niederkrotenthaler et al., 2012, Wilcox et al., 2010) and suicide attempts (Jakobsen and Christiansen, 2011, Kuramoto et al., 2010, Mittendorfer-Rutz et al., 2012). Few studies, however, have investigated risk factors for completed suicide in parentally bereaved offspring, and no study has investigated several risk factors for suicide in combination in order to investigate their relative importance and potential interaction. In a recent review of risk factors for complicated grief in bereaved people (Burke and Neimeyer, 2012), low socioeconomic status (SES) in the form of low education and income was identified as a risk factor. Lack of social support has additionally been found to highly influence the development of depression and complicated grief following bereavement (Burke and Neimeyer, 2012, van der Houwen et al., 2010). Similarly, a lack of family cohesion increased suicide risk in bereaved people (Burke and Neimeyer, 2012), and stigma has been reported to attenuate the association between bereavement and suicide (Pitman et al., 2016). A previous study by Garssen et al. (2011) investigated the influence of a limited number of bereavement-related risk factors on risk of completed suicide in bereaved offspring. They reported a larger suicide risk in sons and daughters whose parents died of suicide compared to offspring whose parents died of other causes, and in offspring who lost a mother compared to offspring who lost a father (Garssen et al., 2011).

The reasons for the variation in responses to loss are largely unknown, and the ability to identify individuals at risk of suicide on the basis of risk and protective factors is limited (Stroebe et al., 2006). It is postulated that the influence of parental loss on offspring's psychosocial wellbeing largely depends on the offspring's inter- and intrapersonal resources, as well as the nature of the bereavement (Stroebe et al., 2006). The interpersonal resources, such as marital status and number of close friends, may reflect possible social support and community network. The intrapersonal factors, such as income, education and mental health problems, may indicate potential capacities in coping and recovery. Bereavement-related factors include for example the cause of death and the quality of the relationship to the deceased, and may reflect the severity of the loss. A better understanding of the relative effect of these factors has clinical importance in its ability to identify individuals at risk and pinpoint the targets of prevention and intervention programs.

In this national population study based on longitudinal registers, our main aim was to investigate to what degree different interpersonal, intrapersonal and bereavement-related factors influence suicide risk in offspring bereaved by parental death from external causes. We also wanted to examine whether the relative importance of these factors on risk of suicide differ by sex and age of the bereaved offspring. External causes of death refer to deaths where the cause is external to the body, such as accidents, suicide and homicide, and do not include death due to illness.

Section snippets

Data sources

We retrieved individual data from three Norwegian longitudinal registers and merged them by means of the personal identification number. Firstly, we retrieved data from the Central Population Register, which has been computerized since 1964 and contains demographic data and a personal identifier for all individuals residing in Norway, as well as their links to legal parents (biological parents and adoptive parents). These links were utilized in order to identify the mother and father of

Results

In our cohort of offspring who were bereaved by parental death from external causes, 375 died by suicide at an age of 12–65 years, including 263 (70.1%) males and 112 (29.9%) females. The mean age at suicide or matching was 40.7 years (SD = 12.6) for the total, 41.6 (SD = 12.2) for females and 40.3 (SD = 12.7) for males. Table 1 shows the distribution of the study variable categories among the suicide cases and their comparison subjects. Compared to bereaved offspring in the control group,

Discussion

The present study has shown that several interpersonal, intrapersonal and bereavement-related risk factors significantly influenced suicide risk in offspring bereaved by parental death from external causes. Being unmarried, separated, divorced or widowed, and having an unstable marital status and residence increased suicide risk. Low income, low education, having an immigration background, and living in medium central municipalities also increased suicide risk. Lastly, losing both parents and

Role of the funding source

This study was financed by the annual budget of the National Centre for Suicide Research and Prevention, funded by the Norwegian Health Directorate.

The funding source had no involvement in the present study.

Acknowledgements

None.

References (36)

  • M.S. Stroebe et al.

    The prediction of bereavement outcome: development of an integrative risk factor framework

    Soc. Sci. Med.

    (2006)
  • H.C. Wilcox et al.

    Psychiatric morbidity, violent crime, and suicide Among children and adolescents exposed to parental death

    J. Am. Acad. Child Adolesc. Psychiatr.

    (2010)
  • E. Agerbo et al.

    Familial, psychiatric, and socioeconomic risk factors for suicide in young people: nested case-control study

    Br. Med. J.

    (2002)
  • K. Andriessen et al.

    Pre- and postloss features of adolescent suicide bereavement: a systematic review

    Death Stud.

    (2016)
  • L.A. Burke et al.

    Prospective risk factors for complicated grief

  • D. Clayton et al.

    Statistical Models in Epidemiology

    (1993)
  • D. Collett

    Modelling Binary Data

    (1991)
  • K. van der Houwen et al.

    Risk factors for bereavement outcome: a multivariate approach

    Death Stud.

    (2010)
  • D. Di Thiene et al.

    Suicide among first-generation and second-generation immigrants in Sweden: association with labour market marginalisation and morbidity

    J. Epidemiol. Community Health

    (2015)
  • K. Dyregrov

    Assistance from local authorities versus survivors' needs for support after suicide

    Death Stud.

    (2002)
  • J. Garssen et al.

    Familial risk of early suicide: variations by age and sex of children and parents

    Suicide Life-Threat. Behav.

    (2011)
  • H.M. Gravseth et al.

    Suicide in young Norwegians in a life course perspective: population-based cohort study

    J. Epidemiol. Community Health

    (2010)
  • M. de Groot et al.

    Course of bereavement over 8-10 years in first degree relatives and spouses of people who committed suicide: longitudinal community based cohort study

    BMJ-Br. Med. J.

    (2013)
  • M.B. Guldin et al.

    Incidence of suicide among persons who had a parent who died during their childhood A population-based cohort study

    JAMA Psychiatry

    (2015)
  • IBMCorp

    IBM SPSS Statistics for Windows, Version 22.0

    (2013)
  • M. Idstad et al.

    Mental distress predicts divorce over 16 years: the HUNT study

    BMC Public Health

    (2015)
  • I.S. Jakobsen et al.

    Young people's risk of suicide attempts in relation to parental death: a population-based register study

    J. Child Psychol. Psychiatry

    (2011)
  • R.C. Kessler et al.

    Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States - Results from the National Comorbidity Survey

    Arch. Gen. Psychiatry

    (1994)
  • Cited by (19)

    • A systematic review on the protective factors that reduce suicidality following childhood exposure to external cause parental death, including suicide

      2020, Journal of Affective Disorders Reports
      Citation Excerpt :

      Guldin et al. (2015) conceded that the psychological health and resilience of the surviving caregiver plays a pivotal role in the child's resources and social networks following bereavement. This was reinforced by Burrell et al. (2017) which found that a strong relationship between the surviving caregiver and bereaved child can enhance the effects of successful bereavement intervention programs. Further, Mittendorfer et al. (2012) emphasised the importance of mothers as critical attachment figures and role models for their offspring, particularly girls.

    • A systematic review on the relationship between childhood exposure to external cause parental death, including suicide, on subsequent suicidal behaviour

      2019, Journal of Affective Disorders
      Citation Excerpt :

      Furthermore, methodological and analytical differences between studies need to be factored in when comparing their outcomes. Limited access to data for variables of interest, for instance with respect to presence of mental health issues in several studies resulted in few conclusive findings regarding their role in offspring suicide (Burrell et al., 2017). There was only one study that separated hereditary and environmental influences on suicidal behaviour by comparing their effects in adopted and non-adopted samples (Von Borczyskowski et al., 2011).

    View all citing articles on Scopus
    View full text